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Empathy and tolerance of ambiguity in medical students and doctors participating in art-based observational training at the Rijksmuseum in Amsterdam, the Netherlands: a before-and-after study
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Stella Anna Bult
, Thomas van Gulik - J Educ Eval Health Prof. 2025;22:3. Published online January 14, 2025
- DOI: https://doi.org/10.3352/jeehp.2025.22.3
- 6,816 View
- 368 Download
- 5 Web of Science
- 5 Crossref
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Abstract
PDF
Supplementary Material - Purpose
This research presents an experimental study using validated questionnaires to quantitatively assess the outcomes of art-based observational training in medical students, residents, and specialists. The study tested the hypothesis that art-based observational training would lead to measurable effects on judgement skills (tolerance of ambiguity) and empathy in medical students and doctors.
Methods
An experimental cohort study with pre- and post-intervention assessments was conducted using validated questionnaires and qualitative evaluation forms to examine the outcomes of art-based observational training in medical students and doctors. Between December 2023 and June 2024, 15 art courses were conducted in the Rijksmuseum in Amsterdam. Participants were assessed on empathy using the Jefferson Scale of Empathy (JSE) and tolerance of ambiguity using the Tolerance of Ambiguity in Medical Students and Doctors (TAMSAD) scale.
Results
In total, 91 participants were included; 29 participants completed the JSE and 62 completed the TAMSAD scales. The results showed statistically significant post-test increases for mean JSE and TAMSAD scores (3.71 points for the JSE, ranging from 20 to 140, and 1.86 points for the TAMSAD, ranging from 0 to 100). The qualitative findings were predominantly positive.
Conclusion
The results suggest that incorporating art-based observational training in medical education improves empathy and tolerance of ambiguity. This study highlights the importance of art-based observational training in medical education in the professional development of medical students and doctors. -
Citations
Citations to this article as recorded by
- Understanding uncertainty and ambiguity in medicine and medical education: a narrative review with implications for training
Sarine Sarkis, Christian Raphael
Postgraduate Medical Journal.2026; 102(1207): 461. CrossRef - Observational training for surgical residents using visual arts in the museum
Thomas M. van Gulik, Stella A. Bult, Pien E.J. de Ruiter, Floortje Huizing, Alexander de Mol van Otterloo, Alexander Leijdesdorff, Sjoerd Lagarde
Surgery.2026; 190: 109843. CrossRef - Training the eye and diagnosing the canvas in the Museum ‘A perspective on art-based medical education’
T.M. van Gulik, S.A. Bult, P.E.J. de Ruiter, F. Huizing, A. Leijdesdorff, S. Lagarde, A. de Mol van Otterloo
Ethics, Medicine and Public Health.2026; 34: 101243. CrossRef - Developing a Feasible Arts and Humanities Course Using Visual Thinking Strategies and Haiku Writing: A Mixed-Methods Study
Hirohisa Fujikawa, Takayuki Ando, Junji Haruta
Medical Science Educator.2025; 35(6): 3105. CrossRef - Erb’s Palsy: Visual Diagnosis in Art before Medical History?
Pien E.J. de Ruiter, Stella A. Bult, Jeroen R. Dijkstra, Thomas M. van Gulik
Gynecologic and Obstetric Investigation.2025; 91(1): 26. CrossRef
- Understanding uncertainty and ambiguity in medicine and medical education: a narrative review with implications for training
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Comparison of the level of cognitive processing between case-based items and non-case-based items on the Interuniversity Progress Test of Medicine in the Netherlands
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Dario Cecilio-Fernandes, Wouter Kerdijk, Andreas Johannes Bremers, Wytze Aalders, René Anton Tio
- J Educ Eval Health Prof. 2018;15:28. Published online December 12, 2018
- DOI: https://doi.org/10.3352/jeehp.2018.15.28
- 22,989 View
- 237 Download
- 15 Web of Science
- 14 Crossref
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Abstract
PDFSupplementary Material
- Purpose
It is assumed that case-based questions require higher-order cognitive processing, whereas questions that are not case-based require lower-order cognitive processing. In this study, we investigated to what extent case-based and non-case-based questions followed this assumption based on Bloom’s taxonomy.
Methods
In this article, 4,800 questions from the Interuniversity Progress Test of Medicine were classified based on whether they were case-based and on the level of Bloom’s taxonomy that they involved. Lower-order questions require students to remember or/and have a basic understanding of knowledge. Higher-order questions require students to apply, analyze, or/and evaluate. The phi coefficient was calculated to investigate the relationship between whether questions were case-based and the required level of cognitive processing.
Results
Our results demonstrated that 98.1% of case-based questions required higher-level cognitive processing. Of the non-case-based questions, 33.7% required higher-level cognitive processing. The phi coefficient demonstrated a significant, but moderate correlation between the presence of a patient case in a question and its required level of cognitive processing (phi coefficient= 0.55, P< 0.001).
Conclusion
Medical instructors should be aware of the association between item format (case-based versus non-case-based) and the cognitive processes they elicit in order to meet the desired balance in a test, taking the learning objectives and the test difficulty into account. -
Citations
Citations to this article as recorded by- From 2024 to 2026: The Evolving Advantages and Limitations of Large Language Models in Mathematics Test Preparation
Zühal Gün Şahin, Zeynep Çavuş Erdem
Sage Open.2026;[Epub] CrossRef - To the Point: Substituting SOAP Notes for Vignettes in Preclinical Assessment Question Stems
Kristina Lindquist, Derek Meeks, Kyle Mefferd, Cheryl Vanier, Terrence W. Miller
Medical Science Educator.2025; 35(3): 1423. CrossRef - Factors Associated with Lower Performance of Artificial Intelligence on Answering Undergraduate Medical Education Multiple-Choice Questions
Renato Ferretti, Joyce Santana Rizzi, Lorraine Silva Requena, Angelica Maria Bicudo, Pedro Tadao Hamamoto Filho
Medical Science Educator.2025; 35(4): 2145. CrossRef - Measuring cognitive levels in high-stakes testing: A CDM analysis of a university entrance examination using Bloom’s Taxonomy
Hamdollah Ravand, Reza Shahi, Farshad Effatpanah, Ali Moghadamzadeh
Frontiers in Education.2025;[Epub] CrossRef - Progress is impossible without change: implementing automatic item generation in medical knowledge progress testing
Filipe Manuel Vidal Falcão, Daniela S.M. Pereira, José Miguel Pêgo, Patrício Costa
Education and Information Technologies.2024; 29(4): 4505. CrossRef - Reliability across content areas in progress tests assessing medical knowledge: a Brazilian cross-sectional study with implications for medical education assessments
Pedro Tadao Hamamoto Filho, Miriam Hashimoto, Alba Regina de Abreu Lima, Leandro Arthur Diehl, Neide Tomimura Costa, Patrícia Moretti Rehder, Samira Yarak, Maria Cristina de Andrade, Maria de Lourdes Marmorato Botta Hafner, Zilda Maria Tosta Ribeiro, Júli
Sao Paulo Medical Journal.2024;[Epub] CrossRef - Development of qualified items for nursing education assessment: The progress testing experience
Bruna Moreno Dias, Lúcia Marta Giunta da Silva, Pedro Tadao Hamamoto Filho, Valdes Roberto Bollela, Carmen Silvia Gabriel
Nurse Education in Practice.2024; 81: 104199. CrossRef - Identifying the response process validity of clinical vignette-type multiple choice questions: An eye-tracking study
Francisco Carlos Specian Junior, Thiago Martins Santos, John Sandars, Eliana Martorano Amaral, Dario Cecilio-Fernandes
Medical Teacher.2023; 45(8): 845. CrossRef - Relationship between medical programme progress test performance and surgical clinical attachment timing and performance
Andy Wearn, Vanshay Bindra, Bradley Patten, Benjamin P. T. Loveday
Medical Teacher.2023; 45(8): 877. CrossRef - Analysis of Orthopaedic In-Training Examination Trauma Questions: 2017 to 2021
Lilah Fones, Daryl C. Osbahr, Daniel E. Davis, Andrew M. Star, Atif K. Ahmed, Arjun Saxena
JAAOS: Global Research and Reviews.2023;[Epub] CrossRef - Use of Sociodemographic Information in Clinical Vignettes of Multiple-Choice Questions for Preclinical Medical Students
Kelly Carey-Ewend, Amir Feinberg, Alexis Flen, Clark Williamson, Carmen Gutierrez, Samuel Cykert, Gary L. Beck Dallaghan, Kurt O. Gilliland
Medical Science Educator.2023; 33(3): 659. CrossRef - What faculty write versus what students see? Perspectives on multiple-choice questions using Bloom’s taxonomy
Seetha U. Monrad, Nikki L. Bibler Zaidi, Karri L. Grob, Joshua B. Kurtz, Andrew W. Tai, Michael Hortsch, Larry D. Gruppen, Sally A. Santen
Medical Teacher.2021; 43(5): 575. CrossRef - Aménagement du concours de première année commune aux études de santé (PACES) : entre justice sociale et éthique confraternelle en devenir ?
R. Pougnet, L. Pougnet
Éthique & Santé.2020; 17(4): 250. CrossRef - Knowledge of dental faculty in gulf cooperation council states of multiple-choice questions’ item writing flaws
Mawlood Kowash, Hazza Alhobeira, Iyad Hussein, Manal Al Halabi, Saif Khan
Medical Education Online.2020;[Epub] CrossRef
- From 2024 to 2026: The Evolving Advantages and Limitations of Large Language Models in Mathematics Test Preparation
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